Most of us don’t think twice about taking analgesics (pain relievers) at the first sign of discomfort. But pain is a symptom, not a disease. Pain is the body’s alerting mechanism that something is wrong. Pain receptors are present almost everywhere, and are triggered by pressure and inflammation. They tell us to avoid the activity which triggered the pain, and allow healing to take place. For this reason, the best treatment for pain is to determine (and avoid) its cause. For example, facial pain may be caused by the teeth, the sinuses, or by TMJ (jaw joint) dysfunction. A root canal, sinus irrigation or a bite guard would address these problems more effectively than analgesics. While we all have occasional aches and pains, chronic or recurrent pain needs to be investigated. I have seen patients who live on aspirin or ibuprofen, but neglect to mention this, since these are over-the-counter (OTC), and somehow seen as not real medicine. In fact, aspirin is not only real medicine, but one of the greatest drugs of the past century. It is probably the best OTC analgesic and anti-inflammatory around.
For the singer, however, aspirin is a double-edged weapon. While its analgesic and anti-inflammatory effects are desirable, its blood-thinning and stomach-irritating side effects are not. Aspirin should be avoided if you are prone to gastroesophageal reflux (GERD), a condition common in women, particularly those who are a bit overweight or have borne children. Acid reflux can irritate the pharynx and vocal folds, causing sore throat and hoarseness.
What about vocal fold hemorrhage? Aspirin can cause this in singers who are predisposed. Predisposing factors include: prominent blood vessels on the vocal folds, menstruation, and Vitamin E or niacin therapy. Keep in mind that even one aspirin can increase the potential for hemorrhage for many weeks (the lifespan of a blood platelet is 120 days).
Be particularly careful with compounds taken for colds, sinusitis, etc. These may contain aspirin, even if not prominently listed. They also contain antihistamines and pseudephedrine, both of which are drying to the vocal folds.
Other analgesics, such as ibuprofen (Advil® or Motrin®) have similar side effects, but to a lesser degree. If you are not predisposed to hemorrhage, you may take these occasionally. Tylenol® (acetaminophen) is also an effective analgesic, but not a particularly good anti-inflammatory. Its main virtue is that it doesnít cause stomach irritation or blood thinning.
Of the more potent analgesics, codeine is the most commonly prescribed, either alone, or in combination (such as Tylenol® with codeine). These medications, along with codeine analogues (such as hydroxycodone) are usually given for acute pain, for a limited period of time. The three significant side effects of codeine are drowsiness, constipation, and habituation. Of these, constipation may be harmful, as straining on the toilet forces the vocal folds together, and may result in trauma, even hemorrhage. Habituation (or addiction) simply means that you will need more and more codeine to achieve the same relief from pain. Drowsiness has a slight but insidious effect on performance.
Alternative methods of pain management should be familiar to every singer. These include acupuncture, massage and chiropractic. Most of these methods work best for muscle-skeletal problems, but acupuncture may also be effective for sinus-related facial pain. Prevention of pain can be achieved with yoga, Alexander and Feldenkrais (for posture), nutritional manipulation (for migraine caused by food allergies), and general stress-reduction methods. If you have persistent or recurrent pain, be prudent about self-medication. Seek medical help to try to sort out the cause of the pain.
